@article{fdi:010083295,
  title = {{B}aseline malaria prevalence and care-seeking behaviours in rural {M}adagascar prior to a trial to expand malaria community case management to all ages},
  author = {{S}ayre, {D}. and {S}teinhardt, {L}. {C}. and {I}rinantenaina, {J}. and {D}entinger, {C}. and {R}asoanaivo, {T}. {F}. and {K}apesa, {L}. and {R}azafindrakoto, {J}. and {L}egrand, {A}. and {P}rada, {N}. and {G}utman, {J}. and {L}ewis, {L}. and {M}angahasimbola, {R}. {T}. and {A}ndriamananjara, {M}. and {R}avaoarinosy, {A}. {V}. and {R}alemary, {N}. and {G}architorena, {A}ndres and {H}arimanana, {A}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {I}ntegrated community case management of malaria, pneumonia, and diarrhoea can reduce mortality in children under five years ({CU}5) in resource-poor countries. {T}here is growing interest in expanding malaria community case management (m{CCM}) to older individuals, but limited empirical evidence exists to guide this expansion. {A}s part of a two-year cluster-randomized trial of m{CCM} expansion to all ages in southeastern {M}adagascar, a cross-sectional survey was conducted to assess baseline malaria prevalence and healthcare-seeking behaviours. {M}ethods: {T}wo enumeration areas ({EA}s) were randomly chosen from each catchment area of the 30 health facilities ({HF}s) in {F}arafangana district designated for the m{CCM} age expansion trial; 28 households were randomly selected from each {EA} for the survey. {A}ll household members were asked about recent illness and care-seeking, and malaria prevalence was assessed by rapid diagnostic test ({RDT}) among children < 15 years of age. {W}eighted population estimates and {R}ao-{S}cott chi-squared tests were used to examine illness, care-seeking, malaria case management, and malaria prevalence patterns. {R}esults: {I}llness in the two weeks prior to the survey was reported by 459 (6.7%) of 8050 respondents in 334 of 1458 households surveyed. {M}ost individuals noting illness (375/459; 82.3%) reported fever. {O}f those reporting fever, 28.7% (112/375) sought care; this did not vary by participant age (p = 0.66). {M}ost participants seeking care for fever visited public {HF}s (48/112, 46.8%), or community healthcare volunteers ({CHV}s) (40/112, 31.0%). {O}f those presenting with fever at {HF}s or to {CHV}s, 87.0% and 71.0%, respectively, reported being tested for malaria. {RDT} positivity among 3,316 tested children < 15 years was 25.4% ({CI}: 21.5-29.4%) and increased with age: 16.9% in {CU}5 versus 31.8% in 5-14-year-olds (p < 0.0001). {A}mong {RDT}-positive individuals, 28.4% of {CU}5 and 18.5% of 5-14-year-olds reported fever in the two weeks prior to survey (p = 0.044). {C}onclusions: {T}he higher prevalence of malaria among older individuals coupled with high rates of malaria testing for those who sought care at {CHV}s suggest that expanding m{CCM} to older individuals may substantially increase the number of infected individuals with improved access to care, which could have additional favorable effects on malaria transmission.},
  keywords = {{MADAGASCAR}},
  booktitle = {},
  journal = {{M}alaria {J}ournal},
  volume = {20},
  numero = {1},
  pages = {422 [13 ]},
  year = {2021},
  DOI = {10.1186/s12936-021-03956-z},
  URL = {https://www.documentation.ird.fr/hor/fdi:010083295},
}